Catherine Jacobson, FHFMA, CPA

The newest reason to redouble our efforts to prevent hospital-acquired infections: We're not going to get paid for these cases.

Hospital-acquired infections have plagued us for centuries. An example near and dear to my heart is "childbed fever." Thanks to modern medical knowledge, this was not a health risk when my three children were born. But in the mid-1800s, many women who gave birth at Austria's Vienna Lying-In Hospital died of this mysterious ailment. The germ theory of disease had yet to be discovered, and physicians routinely moved between autopsies and deliveries without washing their hands, unwittingly spreading bacteria that caused sepsis and death.

An Austrian physician, Ignaz Semmelweis, discovered that handwashing could prevent childbed fever. However, he could not convince others to wash their hands between cases. They considered their colleague's theory far-fetched and his recommendations inconvenient and even offensive.

Many years later, our understanding of infection prevention and control has grown exponentially, but we are still fighting the battle against hospital-acquired infections. Compliance with modern hand hygiene recommendations by physicians and others remains an ongoing challenge.

But we can point to some success stories in the fight against hospital-acquired infections. For example, in July, the U.S. Department of Health and Human Services (HHS) published a report about the Michigan Keystone ICU Project, which promoted the use of a simple checklist during catheter insertions in intensive care units. It led to a 66 percent reduction in catheter-related bloodstream infections, saving more than 1,500 lives and $200 million in the first 18 months. For every dollar invested, $200 was saved. HHS called on other hospitals to replicate Michigan's results by using the same checklist.

Finance leaders should not consider prevention initiatives like this to be the exclusive domain of caregivers, nor should they consider them optional. Since 2008, hospitals that cannot document certain conditions as "present on admission" have faced Medicare payment reductions. Medicare has also stopped paying for what it defines as "never events." As inappropriate as it was, if a sponge was left in a patient after surgery and an operation was required to take it out, hospitals got paid for it. Those days are disappearing, and the movement will continue.

Next on the radar screen: preventable readmissions. On average, 20 percent of Medicare patients are readmitted within 30 days. In 2005, potentially avoidable readmissions cost Medicare an estimated $12 billion, leading the Senate Finance Committee to propose payment withholds for hospitals with high readmission rates. Whether or not that proposal is enacted, the fundamental shift in payment philosophy is clear.

Finance leaders should engage with clinicians to work toward avoiding preventable complications-something both groups want. And we need to develop costing capabilities so we know what these events are costing us. It isn't about the lost revenue any more; it's about preventing the complication and associated costs in the first place.

Shifting our focus toward improving quality to reduce cost-it's a vital way that finance leaders can make it count.

Publication Date: Thursday, October 01, 2009

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